Healthcare Provider Details

I. General information

NPI: 1669796371
Provider Name (Legal Business Name): WEST PLAINS PHYSICAL THERAPY INSTITUTE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2010
Last Update Date: 03/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

906 N KENTUCKY AVE
WEST PLAINS MO
65775-2025
US

IV. Provider business mailing address

906 N KENTUCKY AVE
WEST PLAINS MO
65775-2025
US

V. Phone/Fax

Practice location:
  • Phone: 417-255-2333
  • Fax: 417-255-2332
Mailing address:
  • Phone: 417-255-2333
  • Fax: 417-255-2332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number113699
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number2006030214
License Number StateMO

VIII. Authorized Official

Name: BRADLEY BENDER
Title or Position: OWNER
Credential: MPT
Phone: 417-255-2333